Facilitating Endotracheal Intubation in Difficult Cases Using an External Magnet

Mahin Seyedhejazi, Masood Banaii, Nasrin Taghizadieh, Mahni Mokaber


Difficult airway is conventionally defined as a medical scenario in which a trained examiner faces difficulty in either facemask ventilation or tracheal intubation (1). Unlike difficult intubation, the incidence of difficult mask ventilation in adults is considerable (2, 3). Anesthesiologists and those who practice intubation should be familiar with the management of airway and be able to recognize and identify potentially difficult airways including congenital craniofacial deformities with micrognathia (e.g. Pier Robin, Treacher Collins, Goldenhar's, and Crouzon's syndromes) and metabolic diseases causing the deposition of accumulated by-products (e.g., Hurler's, Morquio's, and Beckwith-Wiedemann syndromes). Cormack and Lehane grades 3 and 4 at laryngoscopy are an indication for advanced techniques for intubation. Laryngeal mask airway (LMA) and fiberscope with a directable tip are useful and important modalities in handling difficult airway and intubation (5).

Even normal pediatric airway could become critical due to the anatomical and physiological differences between pediatric and adult airway; this particularly becomes a concern in infants, i.e. children younger than one year old. This hazard is augmented in the presence of congenital or acquired difficulties affecting airway. Consequently, proper preoperative assessment is considered as the cornerstone of pediatric difficult airway management. Every anesthetic plan should be tailored according to patients considering the scenario and also the expertise of the practitioner. Opting for spontaneous respiration maintenance and intervening in a step-wise manner are strongly suggested (6).

Multiple airway devices have been and are developed that all of which can be placed under direct vision or blindly; most of these devices consistently both provide and maintain safe oxygenation and ventilation. Furthermore, a wide range of ancillary devices have also been introduced to be of assistance in the management of difficult airway; most of them are available in varied sizes suitable for use in children and incorporate a variety of different types of endotracheal tubes, supraglottic devices, fiber-optic, video, optical, and mechanical technologies. Some of these devices (e.g. video laryngoscope) are expensive and not suitable for developing countries with limited financial reserve; some others need high levels of experiences  or learning courses which is not possible for anesthesiologist that are not working  in university hospitals or are less experienced. Some of these devices cannot be used in small children or neonates. Therefore, we were encouraged to look for a device that is easy to use and carry, inexpensive, small in size, and available in all sizes for children, and also does not need special training.

Full Text:



American Society of Anesthesiologists Task Force on Difficult Airway Management. Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists. Anesthesiology 2003 98: 1269-1277.

Kheterpal et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology 2006; 105:885-913.

Langeron et al. Prediction of difficult mask ventilation. Anesthesiology 2000 92:1229 –36.

Tait AR et al. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiology 2008 108:375-80.

KinouchiK.Department of Anesthesia & Intensive Care, Osaka Medical Center and Research Institute for Maternal & Child Health, [Management of difficult pediatric airway]. Izumi 594-1101,Masui. 2006 Jan;55(1):24-32.


Fiadjoe J, Stricker P.Pediatric difficult airway management: current devices and techniques.Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA. [email protected],AnesthesiolClin. 2009 Jun;27(2):185-95.

S Ramesh and R Jayanthi.Supraglottic airway devices in children. Indian J Anaesth. 2011 Sep-Oct; 55(5): 476–482.

Pediatric Anesthesia.Volume 14, Issue 1, pages 28–37, January 2004.

EtsuroK.Motoyama ,PeterJ.Davis.SMITH'S Anesthesia for Infants and children.2006.350-351.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine